The goal of the proposed development program is to prepare the applicant, Joseph W. Shega MD, for a career as an independent investigator and leader in the field of chronic pain in persons with cognitive impairment. The award will provide 5 years of supervised research with the following career objectives: (1) To obtain advanced instruction in pain. (2) To obtain research skills in qualitative methods, survey research, database research, clinical trials, and outcome assessment. (3) To utilize the relationships, skills, and research completed during the award to submit an R-series application. The candidate will achieve these goals through mentored research, coursework, directed readings, and educational activities. Dr. Linda Emanuel the Buehler Professor of Medicine and Judith Paice PhD RN FANN Research Professor of Medicine both at Northwestern University Feinberg School of Medicine serve as co-mentors and will meet with Dr. Shega regularly throughout the award period. His advisory panel includes: (1) D. Weiner-non- cancer pain measurement and functional outcomes, (2) M. Ersek-educational interventions in non-cancer pain, (3) K. Rockwood-large database analysis, (4) T. Schnitzer-analgesic clinical trials, (5) N. Harden- rehabilitation approaches to pain. The proposed research compliments his career development and has two components, an analysis of the Canadian Study of Health and Aging, a large (N=5,703 participants) nationwide population based study (Aims 1, 2, and 3) and a pharmacologic pain management intervention (Aims 4 and 5). The specific aims of this project are to: (1) determine whether cognitive status (no versus mild to moderate cognitive impairment) is associated with the prevalence of non-cancer pain self-report; (2) and (3) describe the association of an older adults 1996 non-cancer pain self-report with 1996 and 2001 functional status (self-report IADL and ADL and TUG) and to determine if 1996 cognitive status modifies this relationship; (4) compare the efficacy of long-acting opioid to extended-release acetaminophen in older persons with no and mild to moderate cognitive impairment and persistent moderate non-cancer knee arthritis pain; and (5) describe the association of change in non-cancer pain self-report with an older adults functional status (TUG and 6-minute walk) and to determine if cognitive status modifies this relationship. RELEVANCE (See instructions): The proposed award provides Dr. Shega with the skills and experience to become an independent investigator in chronic non-cancer pain research. He seeks to apply this paradigm to palliative care and geriatrics populations particularly those with cognitive impairment. Research in this area and population is imperative as then number of persons with cognitive impairment is projected to rise, pain has a substantial physical and psychological impact on older adults, and it remains under treated. [unreadable] [unreadable] [unreadable]